Pelvic/acetabulum fractures are usually the result of high energy injuries such as motor vehicle accidents or falling from an elevated place. Low grade energy causing a pelvic fracture can be associated with a pathological underlying condition.
Associated injuries include femur or any lower limb fractures, spine, chest and abdominal injuries.
There may be haemodynamic shock, especially when associated with polytrauma injuries.
Femur fractures. Exclude associated injuries with acetabulum/pelvic fractures as femur fractures can potentiate haemodynamic instability.
High impact axial loading to the hip joint ± intra-articular fracture:
Pelvis: anterior to lateral view
X-ray AP pelvis
Pelvis: anterior to lateral view
Lateral view
Pelvis: anterior to lateral view
X-ray inlet pelvis view
Pelvis anterior to outlet view
X-ray outlet pelvis view
Anterior view to Judet view
Judet pelvis view rotation to left
Pelvis: anterior to lateral view
Judet pelvis view rotation to right
ASSIS: Anterior Superior Iliac Spine, ITB: Iliotibial band
Kocher-Langenbeck approach
Pin placements:
ASIS: Anterior superior iliac spine
AIIS: Anterior inferior iliac spine
Shock due to blood loss from the pelvic fracture ± associated femur fractures (can cause 1-1,5l of blood loss) or secondary intraabdominal blood loss due to other associated injuries as caused by the high energy trauma associated with pelvic fractures.
DVT is characterized by clot formation within the deep veins.
Virchow described predisposition to vessel clot formation due to changes in the components within the blood circulation, flow change characteristics or vessel wall changes.
DVT predisposes to clot dislodgement with pulmonary spread that may cause sudden death.
Muscle contraction is important to allow blood flow within blood vessels
DVT complication include clot dislodgment with clot spreading to the lungs
Management includes prevention
Fat embolism syndrome is a serious manifestation of fat emboli causing multiple organ dysfunction with lung hypoxia manifesting with shortness of breath with confusion. This may be the direct result of long bone fractures and/or secondary to intramedullary reaming of the femoral canal during the surgical procedure of femur nail and screw fixation.
The two theories causing the syndrome are either a mechanical release of the fat droplets into the venous system or a metabolic stress response causing the changes in the chylomicrons to form fat emboli.
Acute respiratory distress and confusion. Clinical examination will show a tachycardia, tachypnea and petechiae rash in the axillary region, conjunctivae or oral mucosa.
